Parallel improvement of systolic function with surgical weight loss in patients with heart failure and reduced ejection fraction: a systematic review and patient-level meta-analysis.
morbidly obese patients with heart failure with reduced ejection fraction
bariatric surgery
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ejection fraction, New York Heart Association functional class
Abstract
Morbid obesity (MO) is an increasingly common condition in patients with heart failure with reduced ejection fraction (HFrEF). Although substantial weight loss in morbidly obese patients has proved to slow the progression of heart failure, parallel alteration of ejection fraction (EF) and New York Heart Association (NYHA) functional class along with post-bariatric surgery weight loss is yet to be determined. This systematic review aimed to measure the effect of bariatric weight loss on EF and NYHA functional class in patients with HFrEF. A systematic literature review was performed in Medline/PubMed to identify studies in patients with MO and pre-existing HFrEF, who underwent bariatric surgery. A total of 11 studies encompassing 136 patients with HFrEF undergoing bariatric surgery for MO were included. Six studies provided patient-level data on 37 cases. Patients lost an average body mass index (BMI) of 12.9 ± 4.2 kg/m Weight loss induced by bariatric surgery results in parallel EF increase in patients with MO and HFrEF. However, current data does not indicate a parallel improvement of clinical symptoms (NYHA functional class) along with such an increase in EF in this population of patients.